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Managing Family Medical Leave Current State Growing concern for managers – Belief utilization is high and increasing Incomplete FMLA work absence data 1533 DUHS employees had at least one FMLA leave, (continuous or intermittent) during FY 2012 In the beginning of July 2012, DUH had 380 staff members on FMLA (74 continuous and 306 intermittent). 84% of all staff on leave of absence was FMLA. – Decentralized process Variable level of understanding Risks inconsistency in FMLA administration Oversight and monitoring by leadership not in place – Concern growing across health care employers

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DUHS Dashboard FMLA Breakdown by Entity

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Managing Family Medical Leave Current State – Variable utilization of clinical oversight EOHW reviewed 300 FMLA requests from DUHS and University in 2011 Clinical review: 1.Establish parameters for use of FMLA work absence 2.Assess excessive/pattern absence for recertification 3.Address work restriction and reasonable accommodation 4.Evaluate safety concerns due to work restrictions – Increasing complexity FML/ADA and Workers Compensation overlaps

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Managing Family Medical Leave Current State – Lack of utilization of standardized reports Report Express for DUHS 1.Underutilized 2.Data reporting constraints 3.Difficult to track unpaid leave 4.Difficult to track intermittent leave and trends although opportunity exists by broadening utilization of Active Staffer FMLA Exception Reports Available ID cases when FMLA leave is exhausted ID cases where leave data are not entered properly in payroll system situation may not be addressed by dept managers

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Starting Sept. 1, 2012, all Duke University Health System employee requests for Family Medical Leave Act (FMLA) leave must be reviewed by Employee Occupational Health and Wellness (EOHW) for a medical determination of approval. a.The new process does not change the supervisor’s responsibility for determining the eligibility of an employee for FMLA in terms of hours worked. b.The new process requires the Leave of Absence request form and the Health Care Provider forms to be forwarded to EOHW the same day as the employee’s request received. c.Employee has option to provide forms directly to EOHW for high sensitivity diagnosis. Supervisor is still required to meet with employee once approval determination received from EOHW. This change in process is mandatory in the Health System but not for the University. Duke University Managers and supervisors can continue to send paperwork to EOHW for a determination of eligibility, but are not required to do so. Resources for managing FMLA workflow within EOHW have been designated. Utilization metrics will be displayed on the Performance Services Website. Next year, additional changes to enhance tracking of FMLA will be implemented.

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FMLA Healthcare Provider forms, customized for Duke by the following changes from DOL forms: Employee condition form:  Shortened the form by compressing first page of DOL form: Omitted instructions to employer, employee and shortened instructions to HCP.  Included Release of Information allowing clarification if needed. I authorize Employee Occupational Health & Wellness, or its representative, to contact the healthcare provider indicated on this form for clarification or authentication of any of the information below. I also authorize my health care provider to disclose the health information described in this Certification for the purpose of clarification. I understand that I can revoke the above authorization at any time by submitting a written request.

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Family Member condition form:  Shortened the form by compressing first page of DOL form: Omitted instructions to employer, employee and shortened instructions to HCP.  Included Release of Information allowing clarification if needed as above, to be signed by family member.  Added checkboxes for category of relationship of family member: spouse, parent, son or daughter, Duke registered same sex spouse equivalent.  Inserted GINA disclosure, as above.  Rearranged questions to improve flow of document.  Minor changes in wording of some phrases for clarity, e.g., inserted ….needs care “from family member”…

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 to Supervisor and Employee within 1-2 days or supervisor instructing to send Designation notice that clarification is pending.  What is included in the form elements? Approval / Denial Specification of Approval Recertification dates Estimated Frequency of episodic absence Type of Leave (Intermittent, continuous)  New Staff member added to assist with flow  Note: If the employee has no access, department still provides the determination information along with Designation notice

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E-learning currently being developed including: New FMLA self-paced online tutorial including changes offered via SABA LMS for tracking completion Saba LMS User Tutorial offered as pre-requisite New FMLA Mini Tutorials offered via the HR website for Just-In-Time learning Just in Time Learning

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PHASE ONE Employee requests leave of absence PHASE THREE If approved, determine how FMLA will be taken The way in which FMLA is taken will depend on: Medical guidance provided by the staff member’s health care provider and if necessary, confirmed with Employee Occupational Health & Wellness Designation Notice Provided to employee within 5 days for approval or denial PHASE TWO Department determines eligibility (1250 hours and 1 year in last 7 yrs. eligibility) 5 days – Provide Employee Rights and Responsibility Consult with EOHW as needed Approval /Denial PHASE FOUR Determine type of paid time staff member will use. Forward payroll leave of absence form to corporate payroll PHASE FIVE Track and maintain records Business Process (Current)

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PHASE THREE EOHW s determination form to supervisor and employee within 1-2 days or instructs supervisor to send Designation notice that clarification is pending Employee and supervisor meet and discuss EOHW determination form and provide designation notice to employee for approval or denial PHASE TWO Department determines eligibility (1250 hours and 1 year in last 7 yrs. eligibility) 5 days – Provide Employee Rights and Responsibility Same day-Forward LOA Request, HCP, and EE Right and Responsibility to EOHW for determination of FMLA Approval Medical Approval or Denial decision made by EOHW Business Process (Future) PHASE ONE Employee requests leave of absence PHASE FOUR Determine type of paid time staff member will use. Forward payroll leave of absence form to corporate payroll PHASE FIVE Track and maintain records

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New Audit Process  SLR will conduct audit New Audit Process  SLR will conduct audit 1.Request for Leave of Absence form 2.Health Care Provider form 3.Notice of Eligibility and Rights & Responsibilities form 4.Notice of Eligibility and Rights & Responsibility form provided to the employee within 5 business days of when the employee submitted the FMLA paperwork. 5.EOHW provides FMLA determination Notice form 6.EOHW provides FMLA determination Notice form or instructs supervisor to send Designation notice that clarification is pending to the department and the employee via within 1-2 business days. 7.Designation Notice 8.Department must provide Designation Notice to employee within 5 business days of the Health Care Provider notice being submitted. 9.Payroll Leave of Absence Form 10.Confidential File for Staff Member